Fertility FILE

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Moving up in the world.

Back in July, when I first started dabbling with the idea of a blog, I didn't have a good grasp of the enormous potential of this medium. While I am grateful to TypePad for hosting this blog and providing a easy-to-use platform for a beginner like me, it's now time to move up to a format that gives me more flexibility and options. Starting in a few weeks, the new Fertility File site will be self hosted on it's own server!

One of the side effects of the increasing popularity of this site was that patients were finding the blog and then following the links to my private practice website and then coming to me as a patient. While I was glad to have met those patients, especially the ones who are now already pregnant, I've decided to distance the blog from my personal practice in the sense that I don't wish to have the blog perceived as a vehicle to steer traffic to my practice (not that there is anything inherently wrong with that). Still, I've removed the main links to my practice and to my own identity that were originally on this site.

Sure, I realize it wouldn't take a diligent google detective too long to find me, but at least this no longer runs any risk of looking like blatant commercial promotion. This affords me more journalistic freedom to say what's on my mind, without looking like I'm using the blog to drum up business, of which I presently don't have any shortage. The further good news is that I look forward to building up this site and providing more entertaining, useful information. Now those of you who are already my patients or who have already found my practice through other means are still welcome to gain benefit from this blog.

Please take a moment to take this brief survey and help shape the future of this site. Thanks and happy Thanksgiving. I have a lot to give thanks for!

Q & A : November 14, 2007

Hello,
   I am very confused, and maybe you can help. Here is my story, it is short compared to most but still no one seems to agree on the problem. I delivered a healthy baby girl in 2004 at age 26. At 29, I got pregnant again in March, but lost the baby in April. Both times I got pregnant immediately, the first month of trying. I have now been trying again for 6 months. I have regular periods, like clockwork, grab a pad in the morning before I even start kinda regular (29-30days). They did a vaginal ultra sound to check on a small, tiny fibroid i have, there are no more, and it is small... too small to cause problems. At this time the meanie, yucky, ultra sound lady tells me my ovaries are the size of a post menopausal women, and that I most likely have POF, and to start thinking about adoption. I thought I would puke on the table. Now, they are wanting me to go through a battery of tests, calling this "being aggressive" and have ordered all the bloodwork and even the HSG. Now, I am only 30 years old, and everything I've read about POF presents with missed periods... Anyway, my question is, do you think these tests are necessary? Does it matter in the least that I have regular periods? Or that I got pregnant on my own 6 months ago? Why is everyone talking about "being aggressive"?
-Tara in KS

Dear Tara,
    I don't know your entire story of course, but based on what you provide, I would agree that your instincts are correct that there may be some overreaction here. If I read you correctly, you are 30, got pregnant very easily and delivered a healthy girl. Then you got pregnant again immediately upon trying at age 29, but sadly, lost the pregnancy in the first trimester. Now, it had been six months and no pregnancy. Based on this information alone, it would be hard-pressed to say that you have any problem at all. There's nothing abnormal about having one miscarriage. There is nothing abnormal about six months passing without getting pregnant.
    Again, according to your email, your doctors are telling you that they are very concerned because your ovaries are small on ultrasound. You don't provide any measurements saying just how small they are, but still, if you got pregnant on your own six months ago and are having regular periods, I don't see the need yet to get "aggressive". The blood test you are talking about is probably a FSH level. That's not an unreasonable thing to get because it's inexpensive and easy to do. The HSG, on the other hand, is more expensive and invasive. It also puzzles me why they would get an HSG to address a suspicion of POF. POF is an ovarian problem. HSG's give information about the uterus and tubes, not the ovaries. In any case, my best advice is to have a quality discussion with your doctors. They might have some additional information that you are not providing here. I really hope you get pregnant on your own again, and soon. Good luck!!

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Don't worry, I won't quit my day job...

Four months ago, I was just a doctor who loved his work. Two months ago, I was a doctor and a newbie blogger. Today? Well, that's still what I am today, for now anyway. I just finished attending the 2007 BLOGWORLD Expo in Vegas where I rubbed shoulders with some of the greatest bloggers in the world. Here were people, all with very different stories, but who shared one thing in common, a great love and ability for sharing their thoughts and emotions with their captive audiences throughout the internet world. The meeting ended with a stirring talk by Mark Cuban, passionately sharing his experience with his own blog. It was a humbling experience for me, and I loved it!

For years, I've been on the other side of the lectern, giving talks and sharing my knowledge and expertise on infertility with hundreds of doctors and medical students in my position as a faculty member of a medical school (now of TWO medical schools as of earlier this year). I also had gotten into the habit of doing a fair amount of informal teaching, complete with handouts and diagrams, to my own patients during their day-to-day care. So here I was at the Expo, no longer the teacher, now the newbie student, absorbing an overwhelming amount of information in a field I previously knew little about, realizing with excitement that there was a whole new world for me to explore.

So for now, I will keep on learning and improving this site for you. I love your feedback, so keep it coming!

Could I be pregnant?

One of the most common questions women ask themselves when they are trying to conceive is "Could I be pregnant?" It's very normal and common to become a little obsessed with this without your even realizing it. This question usually pops into your mind during the time between when you have ovulated and the time when you expect your next period to come (or hopefully, NOT to come). For those of you undergoing fertility treatment, it is especially strong and starts to occur after your insemination or your embryo transfer.

Bear in mind that during the times in your life when you were NOT yet trying to conceive, you have had different feelings on different days. Some days, you might be more tired than others. Some days, you might get a headache or momentarily feel a rumbling in your stomach. You might have soreness in your breasts on occasion. All these things go unnoticed. However, when you are focused on conceiving, it is normal for you to pay meticulous attention to each little change. Your mind will start to play tricks on you and you will associate every little change with the possiblity of pregnancy. "Does the fact that my back aches mean that I'm feeling implantation?" "Does the increase in my appetite despite my feeling a little bloated mean I'm pregnant?" "I can't describe it but something just feels a little different these past few days, maybe it means I'm pregnant?"

When my patients undergo fertility treatment and come in on the big day when they get their blood drawn to see if they're pregnant or not, I often get to inquire how they're feeling. They are a little nervous that day, of course. Sometimes, however, they will share some additional information about some new thing they're feeling, such as being very tired or very hungry or a little nauseous or urinating a lot or noticing breast swelling or feeling like their face is glowing or having strange cramping. They often volunteer a guess as to whether their test will come back positive or not. I always tell them that we'll have their result back in an hour once we run their blood through our machine and only then can we know for sure.

From years of this, I am convinced that very few women are truly able to predict with 100% accuracy if they're pregnant or not. There was this one patient who has three babies with us in her life. She required a total of seven insemination treatments to have her three successes. The first two cycles were unsuccessful, while the third resulted in her first son. A year later, the fourth cycle resulted in her second son. A few years later, she came back and failed cycles #5 and #6 before getting pregnant on cycle #7 with her third child, a daughter. Each time, when getting her blood drawn she would either look dejected and say, "I know I'm not pregnant" OR she would beam with joy and say "I know it worked this time". Each of the seven times, she was correct! My staff would marvel at her uncanny ability and we joked that we shouldn't even bother doing her tests.

However, there have been other times when patients came in for their blood test with shining optimism that they knew they were pregnant, but when the results came off the machine, it turned out they weren't. More commonly, there are patients who come in and sadly share that they have already had a little bleeding and they feel that their period is coming, so why even bother testing. Many many times, the tests are positive and the patients go on to have a healthy baby! My point is that pregnancy tests are the best way to accurately know if someone is pregnant or not. All the little symptoms you notice may or may not mean something.

By the way, when I questioned that one patient what symptoms enabled her to predict so accurately all the times she was pregnant, she burst out laughing and confessed, "Doctor, I cheated! I always do a home pregnancy test in the morning before I come in for my blood test."